Perioperative respiratory adverse events in children undergoing adenotonsillectomy with laryngeal mask airway versus endotracheal tube ventilation: multicentre, randomised controlled trial

AI Summary

A multicentre randomised trial in four hospitals in China compared laryngeal mask airway (LMA) ventilation with endotracheal tubes during adenotonsillectomy in 400 children. Perioperative respiratory adverse events occurred in 22.5% of the LMA group versus 57.5% of the endotracheal tube group, and neither group experienced serious adverse events.

AbstractObjectiveTo assess the effect of ventilation with a laryngeal mask airway (LMA) compared with endotracheal tube (ETT) on perioperative respiratory adverse events (PRAEs) in children undergoing adenotonsillectomy.DesignMulticentre, randomised, parallel group trial.SettingFour tertiary hospitals in China, 2023-24.Participants400 children aged ≥2 years and <7 years who were scheduled for adenotonsillectomy under general anaesthesia.InterventionsParticipants were randomised 1:1 to receive ventilation with a laryngeal mask airway (n=200) or an endotracheal tube (n=200) during adenotonsillectomy.Main outcome measureThe primary outcome was the proportion of participants who developed any perioperative respiratory adverse event (PRAE): laryngospasm, bronchospasm, desaturation, airway obstruction, severe cough, or stridor in the intention-to-treat population.Results400 children (mean age 4.7 (standard deviation 1.0) years; 155 (38.7%) girls) were enrolled between 24 May 2023 and 4 April 2024, with last follow-up on 4 May 2024. LMA was converted to ETT in three participants. Overall, 22.5% (45/200) participants in the LMA group experienced PRAEs versus 57.5% (115/200) in the ETT group (absolute risk difference -35.0 percentage points, 95% confidence interval -43.5 to -25.7; P<0.001). The LMA group had fewer PRAEs in both the intraoperative (9.0% (18/200) v 17.5% (35/200); -8.5, -15.2 to -1.8; P=0.01) and the postoperative period (16.5% (33/200) v 49.5% (99/200); -33.0, -41.2 to -24.0; P<0.001). The LMA group also had a lower proportion of participants with laryngospasm (0.0% v 3.0%; P=0.03), desaturation (15.0% v 28.0%; P=0.002), airway obstruction (3.5% v 12.5%; P<0.001), and severe cough (10.5% v 42.0%; P<0.001). Neither group experienced serious adverse events.ConclusionVentilation with an LMA by experienced anaesthesiologists resulted in fewer perioperative respiratory adverse events than ventilation with an ETT in children undergoing adenotonsillectomy.Trial registrationChictr.org.cn ChiCTR2300071399.